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English Abstract

Background Selective serotonin reuptake inhibitors (SSRIs) are widely used in treating depression but their efficacy remains controversal among systematic reviews of randomized controlled trials (RCT). Most of the RCTs on Chinese patent medicines for treating depression used SSRIs as controls. Thus, the efficacy of antidepressant Chinese patent medicines is to be vertified after comfirming the SSRIs' efficacy. Aims This study aims to verify the efficacy of SSRIs and antidepressant Chinese patent medicines by meta-meta analysis (MMA), meta-reanalysis (MRA) and meta-analysis rerun (MAR). Methods Systematic reviews and RCTs comparing efficacies of SSRIs, placebos and Chinese patent medicines in treating adult depression patients were searched from PubMed, ScienceDirect, Cochrane Library, WanFang, CNKI and selected according to pre-specified search strategies and eligibility criteria. The final retrieval date was 28 May, 2013. PRISMA checklist, Jadad scale and Cochrane risk of bias tool were used to evaluate the quality of included systematic reviews and RCTs. Meta-analysis based on a random-effects model was conducted with outcome measures including responses, remissions and changes from baseline of the depression scales HAMD, MADRS and CGI. Odds ratio (OR) and standardized mean differences (SMD) with 95% confidence intervals (CI) were used to represent dicohotomous and continuous outcomes. Subgroup analysis and sensitivity analysis were conducted to evaluate the meta-analysis findings. Funnel plot, Begg’s test and Egger’s test were used to analyze the publication biases. Main results MMA included 6 studies with a total of 40 RCTs including 7515 participants. The overall OR was 1.49(95% CI [1.28, 1.73];P

Chinese Abstract

背景:选择性5-HT再吸收抑制剂(SSRI)是治疗抑郁症的一线用药,但SSRI治 疗抑郁症的荟萃分析呈现相反的结果。而且中药治疗抑郁症的荟萃分析中对照药 物多为SSRI, 若SSRI的疗效尚存在争论,中药的疗效便无法确定。 目的:本研究针对 SSRI 对比安慰剂治疗抑郁症的荟萃分析进行二次荟萃分析 (Meta-meta analysis, MMA)和再次分析(Meta-reanalysis, MRA),解释发表的 荟萃分析出现相反结果的原因;通过剔除可能混杂的因素,已发表的抗抑郁药(本 研究只包括 SSRI 和中药)治疗抑郁症的临床随机试验(RCT)进行重新荟萃分 析(Meta-analysis rerun, MAR),确定 SSRI 对比安慰剂、中药对比安慰剂以及中 药对比 SSRI 治疗抑郁症的疗效。 方法:检索的数据库为中国期刊全文数据库、万方数据库、PubMed、ScienceDirect 和Cochrane Library,检索的文献发表时间为1994至2013年,最后检索日期为2013 年5月28日。检索发表关于SSRI 治疗抑郁症的系统评价报告以及SSRI 对比安慰 剂、中药对比安慰剂以及SSRI 对比中药的RCT 报告。实验对象为年满18岁的成 年抑郁症患者,治疗组使用抗抑郁药治疗,安慰剂作为对照治疗以及治疗组使用 中药治疗,SSRI作为对照治疗。疗效结果的评价指标针对HAMD、MADRS 和 CGI 三个抑郁量表采用有效率、治愈率和基线改变情况衡量抑郁症症状的改善 情况。通过对纳入的系统评价采用PRISMA 检查清单进行质量的评价,通过对 纳入的RCT 采用Jadad 评分量表和Cochrane 偏倚风险评估量表进行质量的评价。 采用优势比(OR)表示有效率和治愈率的效应值,采用标准均数差(SMD)表 示基线改变情况的效应值,继而根据纳入文献的基本特征,进行亚组分析和敏感 性分析。 结果:二次荟萃分析(MMA)包括了 6 篇系统评价,其中 4 篇系统评价的结论 为 SSRI 有效,2 篇认为无效。6 篇系统评价纳入的 RCT 中有 40 个 RCT 报告了 有效率,8 个 RCT 报告了痊愈率,5 个 RCT 报告了基线的改变情况。有效率的优 势比(OR)为 1.49(95% CI[1.28,1.73];P

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Institute of Chinese Medical Sciences






Depression, Mental -- Treatment

抑鬱症 -- 治療



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